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PubMed2006

Trends in service provision among Australian private general dental practitioners over a 20-year period.

AIM: To-investigate time trends in service provision. DESIGN: Five cross-sectional surveys across a 20-year period. SETTING: Australian private general practice PARTICIPANTS: A random sample of dentists. METHODS: Mailed questionnaires were collected in 1983, 1988, 1993, 1998 and 2003 (response rates 71%-76%). MAIN OUTCOME MEASURES: Services per visit, annual services per dentist; annual services per patient. RESULTS: Total services per visit increased over the study period from 1.78 to 2.37 (Poisson regression; P<0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased from 3.47 to 5.50 (OLS regression; P<0.05), reflecting both increased service rates per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more diagnostic, preventive, endodontic and crown and bridge services. The annual care received per patient also included more diagnostic, preventive, endodontic and crown and bridge services but differed from the dentist pattern through increased rates of restorative services over the study period. CONCLUSIONS: The content of dentist workloads has changed to include less emphasis on removal and replacement of teeth and more effort on diagnosis and prevention aimed at retention of natural dentitions.

Adolescent↗
PubMed2003

The role of professional journalism in protecting against questionable practice.

The editor in chief of the Journal of the Canadian Dental Association explains that professional journalism alone cannot be expected to protect against questionable practice but it plays a vital role in the network of resources that define standards of excellent and ethical care. According to some, the explosion of biomedical information has created a crisis as emerging science overwhelms practitioners' capacity to intelligently evaluate it and incorporate it into practice. Research in medicine shows that journals play only a part in decisions regarding practice patterns. Some initiatives taken by the Canadian Dental Association to publish professional literature relevant to practitioners' needs to remain current in order to prevent questionable dental practice are described.

Canada↗
PubMed2002

Survey of dental radiographic services in private dental clinics in Damascus, Syria.

OBJECTIVES: To perform a radiographic survey of private dental clinics in Damascus, Syria using a postal questionnaire to produce recommendations for improving the quality of dental radiographic services and education in Syria. METHODS: Three hundred private dental clinics in Damascus were surveyed using a postal questionnaire (in English and Arabic) containing 27 questions on demographic information, equipment, techniques, selection criteria, frequency of examinations, and undergraduate/ postgraduate education. RESULTS: Two hundred and two (67%) dentists responded of which 95% graduated in Syria. The results showed a general lack of knowledge and understanding of dental radiography. Sixty four per cent did not know the kVp setting of their equipment, 73% used D-speed film, 57% did not use film holders and beam aiming devices, 25% did not use a viewing box. In addition, 45% of known equipment operated at 50 kVp or less and 16% was over 20 years old. No meaningful selection criteria existed with a wide variation in type and frequency of radiographs used for different clinical conditions. Syrian undergraduate training in dental radiology was minimal and there was no postgraduate education in the speciality. CONCLUSIONS: Several areas of the radiographic service in Damascus fall short of current recommendations on good practice. Recommendations are made to improve the service, the quality of undergraduate education and to establish postgraduate education.

Adult↗
PubMed2005

Oral health workforce in rural and remote Western Australia: practice perceptions.

OBJECTIVE: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. DESIGN: A postal survey was undertaken among all registered oral health professionals in Western Australia. SETTING: Rural and remote Western Australia. PARTICIPANTS: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. RESULTS: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. CONCLUSIONS: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.

Adult↗
PubMed2006

Orthodontic treatment provided by general dentists who have achieved master's level in the Academy of General Dentistry.

INTRODUCTION: The purposes of this study were to document orthodontic treatment currently provided by general dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. METHODS: A 21-item survey was mailed to 750 master's level members of the Academy of General Dentistry. Surveys returned within 8 weeks were included for statistical analysis. RESULTS: The response rate was 62%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Many provided orthodontic treatment in the permanent dentition, and the most common conditions or malocclusions treated were space maintenance, anterior crossbite, rotation, habits, molar uprighting, and posterior crossbite. The most common orthodontic appliances used were removable Hawley appliances with finger springs, straight wire orthodontic therapy, rapid palatal expanders, and functional appliances. CONCLUSIONS: The number of general dentists providing comprehensive orthodontic treatment has not changed since previous surveys; practitioners also do not expect a change in the next 5 years. Factors that influenced the orthodontic treatment provided included the primary source of orthodontic training, the number of orthodontic continuing education hours earned per year, the practitioner's location, and the proximity to the nearest orthodontist.

Adult↗
PubMed2004

[What do dental students think about their future career practice? Differences between men and women].

Aim of this study was to get more insight into the career choice, plans and expectations, and practice pattern preferences of male and female dental students in The Netherlands. A structured questionnaire was sent out to all 5th year dental students in The Netherlands in the academic year 2001/2002 (n = 258). The overall response was 65%. Both male and female students prefered working in a group practice environment rather than a solo practice, in which significant more males prefered ownership. Only 23% of the males and 7% of the females expected to work full time in the future. An important factor was leisure time, but for the female students 'taking care for children' was still decisive. The new job description 'oral physician' for the future dentist as advocated by Dutch health authorities was found less attractive than the present profession 'dentist'. Only a quarter of the females and half of the males is interested to serve as manager of a team of dental health professionals. It is concluded that male and female dental students differ in their plans and expectations with respect to their future career choices and practice pattern preferences. As the majority of the present dental students is female this will have a major impact on the dental profession.

Adult↗
PubMed1998

Variation in periodontal referral by general dental practitioners.

This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

Adult↗
PubMed1997

Dentists' HIV-related ethicality: an empirical test.

This article attempts to determine to what extent, in the context of treating HIV+ patients, a sample of New York dentists has attitudes, opinions, experiences, and reported behaviors which are consistent with the core ethical principle that "the dentist's primary professional obligation shall be service to the public." The article explores and reports differences in these characteristics in two groups of dentists, one strongly agreeing that dentists are ethically obligated to treat HIV+ patients and one strongly disagreeing with the same proposition. Acceptance of extra exposure to risk among health professionals seems not to be as pervasive as it once was. Conspicuous differences in perceived risk, safety, and potential loss of income associated with HIV, as well as concerns about treating homosexuals, are apparent between the two groups of dentists mentioned above.

Attitude of Health Personnel↗
PubMedDate not supplied

Patients with special health care needs in pediatric dental practices.

PURPOSE: The objective of this study was to determine the involvement of pediatric dentists in practice in managing patients with special health care needs (SCHN) upon completion of training. METHODS: A questionnaire was developed, pilot tested, modified and sent to a randomly selected sample of 950 pediatric dentists in practice who were active and fellow members of the American Academy of Pediatric Dentistry. RESULTS: Fifty-one percent of the dentists responded. The majority were males between the ages of 41 and 50 years. Most practiced in communities with over 500,000 citizens. Most were trained in hospital-based programs, and 84% reported comprehensive didactic courses on SHCN patients during training. SCHN patients were routinely appointed in an integrated schedule in their practices. Seventy-one percent of responders continue to follow the patients after 21 years of age. Most had buildings and offices that were handicapped accessible. Patient profiles remained similar since initiating private practice with notable increases reported in the new and recall patients and patients with complicated medical histories categories. CONCLUSIONS: The results of this survey demonstrate the continuing involvement of pediatric dentists in private practice in scheduling and treating patients with special health care needs after the completion of training.

Adult↗
PubMed1996

Factors affecting the amount of long-term restorative dental treatment provided to 100 patients by 20 dentists in 3 Adelaide private practices.

Apart from the effects of the frequency of patient attendance for dental examination, and of a change of dentist, little is known of those factors which may influence the amount of treatment provided in dental practice. The present study investigated during 1992 the effects of seven factors on the amount of treatment provided for 100 adult patients treated by 20 male dentists over many years in three selected Adelaide private practices. The amounts of particular types of restorative treatments provided were significantly related to patient age, gender and frequency of attendance, and to practice location, change of dentist and number of changes of dentist, and to the experience or time since graduation of the dentist. These factors were of special significance for the number of crowns provided, most of which were placed in older patients by more experienced dentists. But, there was no evidence of increased numbers of direct placement restorations being received by patients who attended more frequently or who changed their dentists.

Adult↗
PubMed1997

Practice profile differences among Swedish dentists. A questionnaire study with special reference to prosthodontics.

A questionnaire measuring differences in prosthodontic practice profiles was sent to 2100 Swedish dentists working as general practitioners. The response rate was 76%. Among the responders, 58% were men and 42% women. Fifty per cent were private practitioners, the other 50% being publicly employed. The practice profile variables showed a great variation, and several of the distributions differed with regard to sex and dental care system. The working hours per week the time spent on prosthodontics were on average higher for men than for women. Private practitioners more frequently worked in large communities and cities than did dentists working in the Public Dental Health Service. Practically all (98%) of the private practitioners used more than 75% of their clinical time on treating adults, compared with less than half of the dentists in the Public Dental Health Service. Male dentists reported higher percentage figures with regard to clinical time used for dental care of adults and for prosthodontic services than did female dentists. The figures for fixed prosthodontic service rates varied in the same manner. Fixed prosthodontic services were much more common in private practice than in the Public Dental Health Service, in which more removable dentures were made. Even though private practitioners used more time for prosthodontic services, they referred fewer patients to specialists in prosthodontics and consulted a specialist less often than did the dentists in the Public Dental Health Service.

Adult↗
PubMed1997

Factors influencing the appropriateness of restorative dental treatment: an epidemiologic perspective.

OBJECTIVES: An epidemiology analysis was performed to identify patient and dentist factors influencing over- and undertreatment of restorative services in a sample of insured adults. METHODS: At baseline, 681 Washington State employees and their spouses, aged 20 to 34 years and residing in the Olympia or Pullman areas, were interviewed by telephone. Oral assessments were conducted to measure personal characteristics, oral disease, and restoration quality. Adults were followed for two years to measure use of restorative services from dental insurance claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment. RESULTS: For overtreatment, 39 percent of adults received one or more replacement restorations in nondecayed teeth with satisfactory fillings at baseline, while 18 percent of adults had one or more restorations placed in teeth with no decay and fillings. An adult's probability of overtreatment was higher if the adult had more fillings at baseline, or if an adult's dentist was younger, had a busy practice, advertised, charged higher fees, had less continuing education, or had a solo practice. For undertreatment, about 16 percent of adults either received no replacement restorations in teeth with unsatisfactory fillings at baseline, or had decayed teeth at baseline that were not filled or crowned. An adult's probability of undertreatment was higher if an adult had less decayed or more missing surfaces at baseline, or if an adult's dentist believed in sharing information with patients, had a busy practice, or reported not placing fillings when radiographic evidence of new caries was present. CONCLUSIONS: A minority of adults aged 20 to 34 experienced potential over- or undertreatment of restorative services, which are influenced by both patient and dentist factors.

Adult↗
PubMed2006

Incidence of periodontal diagnosis in private dental practice.

PURPOSE: To evaluate the rates of periodontal examination in private dental practices in Brazil. METHODS: 235 dentists, 117 female and 118 males (mean age 33.1 years), presenting different levels of experience (mean: 11.2 years) were audited. In each dental practice, a team of two trained auditors evaluated dental examination kits for the presence of a periodontal probe, and checked whether there was any specific diagram to record the periodontal status of the patient in the model of clinical charts. The dentists were then asked whether or not they performed periodontal probing and radiographic examination of periodontal structures in all their patients. The degree of association between variables was evaluated using Chi-square or correlation tests. RESULTS: The dentists, 117 female and 118 males, were from 22 to 62 years old (mean age, 33.1 years), and presented 0.5 to 40 years of experience (mean of 11.2 years). Of the 235 clinicians, 19.3% performed periodontal probing in all their patients, and 17.5% of them record the periodontal examination, 48.9% of the professionals occasionally performed periodontal probing while 31.8% did not perform periodontal probing at all. Specialists in prosthodontics, and dentists having more than two specialties, excluding periodontists, performed periodontal probing more frequently than other specialists.

Adult↗
PubMed2001

A study of endodontic treatment carried out in dental practice within the UK.

AIM: The purpose of this study was to gather both qualitative and quantitative information on the nature of root canal treatment carried out by a group of dentists working within the United Kingdom. METHODOLOGY: A two-part questionnaire was posted to 720 dentists who graduated from the Dental School, Cardiff, Wales, UK. The first part requested basic information regarding age, year of qualification, field of practice, etc. The second part consisted of 15 questions on endodontic practice and root canal treatment. RESULTS: The response rate was 41.5%. Two hundred and ninety-nine questionnaires contained useful information. The majority of practitioners did not use rubber dam during root canal treatment. The vast majority (89%) exposed a radiograph with an instrument of known length in situ to gauge the 'working length', a small number relied upon tactile sensation. Most practitioners used local anaesthetic solution as an irrigant during instrumentation of the root canal. A wide variety of instruments were used for root canal treatment; a stepback technique was preferred by almost half the practitioners. Antiseptic solution was preferred as an interappointment dressing. More than half of the respondents used laterally condensed gutta-percha to obturate root canals in anterior teeth but only one-third used the same technique in posterior teeth. Less than half the respondents exposed a radiograph to check the fit of the master point prior to obturation. Two-thirds of practitioners used a zinc oxide based material as their root canal sealer. Three-quarters of the practitioners exposed a post obturation radiograph. CONCLUSIONS: The results of this study suggest that although some dentists are using the techniques taught during their undergraduate careers, a large percentage now use techniques with no evidence of clinical effectiveness.

Adult↗
PubMed2005

Practice patterns among male and female general dentists in a Washington State population.

BACKGROUND: Women make up about 14 percent of general dentists in the United States, and the proportion is projected to exceed 29 percent by 2020. METHODS: The authors obtained dental benefits claims data from the Washington Dental Service (WDS), Seattle, and used them to examine the practice patterns of 265 women and 1,947 men engaged in general dentistry for at least 26 days in 2001. Practice variables of interest included age, days worked, procedures performed and total income from WDS reimbursements and patient copayments. The number, age and sex of patients treated also were obtained. Using productivity data, the authors also estimated the potential impact of an increase in the percentage of female dentists in the state. RESULTS: The authors found no differences between male and female dentists in the number of procedures per patient, income per patient or income per day of work. Frequency distributions of various services were highly similar for both groups. Multiple regression models showed no influence of dentist's sex on total income. However, the mean and median numbers of days worked were about 10 percent lower for female dentists than for male dentists. This difference was consistent with the finding that female dentists treated approximately 10 percent fewer patients, performed about 10 percent fewer procedures and had a combined income of about 10 percent less than that of male dentists. CONCLUSION: Practice patterns of male and female dentists generally were equivalent in this WDS population. CLINICAL IMPLICATIONS: Female and male dentists provided a similar range of services and earned an equal income per patient treated and per day worked. However, women worked fewer days per year than did men, irrespective of age. If the dental work force and practice patterns remain unchanged otherwise, the total number of patients treated per dentist will decrease slightly as women make up an increasing proportion of dentists.

Adult↗